Crying Child Over 3 Months
DEFINITION
- Excessive crying, irritability or fussiness
- Child is too young to tell us or show us the cause for his crying
- Crying from an illness or physical symptom should be triaged using that topic
Causes
- Main cause: coming down with an illness. Young children cry about being sick, even if they don't have any pain.
- Physical Pain: Painful causes include earache, sore throat, mouth ulcers, raw diaper rash, meatal ulcer on tip of penis, constipation.
- Behavioral causes: overtired, stressed, whining, tantrums, separation anxiety. This topic detects many infants with sleep problems. Crying also occurs during sleep habit re-training programs. Some preverbal children (before 2 years) cry for everything.
- Teething: Teething generally doesn't cause pain or crying.
- Gas: Gas in the intestines does not cause crying.
- Hunger: Not caused by hunger, since by this age you can recognize hunger.
- Decongestants (pseudoephedrine or phenylephrine) also can cause jitteriness and crying in some children. (Note: FDA does not recommended cough and cold medicines for children under 4 years.)
See More Appropriate Topic (instead of this one) If
- FEVER or any symptom of illness (e.g., diarrhea or constipation), see that topic
- Crying from an injury, see specific INJURY topic
- Immunization(s) within the last 4 days, see IMMUNIZATION REACTIONS
WHEN TO CALL YOUR DOCTOR
Call 911 Now (your child may need an ambulance) If
- Not moving or very weak
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Stiff neck or bulging soft spot
- Won't move one arm or leg normally
- Cries every time if touched or moved
- Possible injury (especially head or bone injury)
- Very irritable, screaming child for over 1 hour
- You are afraid you or someone might hurt or shake your baby
- Crying continuously (cannot be comforted) for more than 2 hours
- Refuses to drink or drinking very little for more than 8 hours
- You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
- You think your child needs to be seen, but not urgently
- Pain (e.g., earache) suspected as cause of crying
- Crying intermittently (can be comforted) BUT child not acting normally when not crying
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
- Mild, off-and-on fussiness (acts normal when not crying) continues over 2 days
- Excessive crying is a chronic problem
Parent Care at Home If
- Mild fussiness of unknown cause present less than 2 days and you don't think your child needs to be seen
- Normal protest crying
- Temper tantrum crying
- Sleep problem crying
HOME CARE ADVICE FOR MILD CONSOLABLE CRYING
Reassurance:
- Your child is crying and fussing more than usual, but acting normal when not crying.
- He could be coming down with an illness and that will usually become clear in a day or so.
- He could be reacting to some changes in your home or child care setting. See if you can come up with some ideas.
- Children can also temporarily go through a "clingy phase" without an explanation.
- If the crying responds to comforting, it's probably not serious.
Comforting: Try to comfort your child by holding, rocking, massage, etc.
Sleep: If your child is tired, put him to bed. If he needs to be held, hold him quietly in a horizontal position or lie next to him. Some overtired infants need to cry themselves to sleep.
Undress Your Child: Sometimes part of the clothing is too tight or uncomfortable. Also check the skin for redness or swelling (e.g., insect bite).
Discontinue Medicines:
- If your child is taking a cough or cold medicine, stop it.
- The crying should stop within 4 hours.
- Antihistamines (e.g., Benadryl) can cause screaming and irritability in some children.
- Pseudoephedrine (decongestant) can cause jitteriness and crying.
- The FDA does not approve any of these medicines for children under 4 years old.
Expected Course: Most fussiness with illnesses resolves when the illness does. Most fussiness due to family stress or change (e.g., new day care) lasts less than 1 week.
Call Your Doctor If:
- Constant crying lasts over 2 hours
- Intermittent crying lasts over 2 days
- Your child becomes worse
Normal Protest Crying
Reassurance:
- Normal children cry when they don't get their way.
- Normal children cry when you make changes in their routines.
- Crying is their only form of communication in the first years of life.
- Crying can mean, "I don't want to".
- This is called normal protest crying and is not harmful.
- Do not assume that crying means pain.
Temper Tantrum Crying
Reassurance:
- Crying is the most common symptom of a temper tantrum.
- This is likely the cause if most of the crying occurs when your child is angry, upset or trying to get his way.
- All kids have some temper tantrums, starting at about 9 months of age.
Tips for Responding to Temper Tantrums:
- Ignore most tantrums (e.g., demanding something the child doesn't need).
- For tantrums from frustration (e.g., when something doesn't work), help your child.
- For aggressive (hitting) or destructive (throwing) tantrums, put in timeout until your child calms down.
- Don't give in to tantrums. No means No.
- Be a good role model. Avoid yelling or screaming at others (adult tantrums).
Sleep Problem Crying
Reassurance:
- Your child may have a sleep problem if most of your child's crying occurs when you put him in his crib (or bed) and at night. Suspect a sleep problem if your child acts normal during the day.
- Sleep problems are common in childhood.
Tips for Treating the Sleep Problem:
- Re-train your child to be a good sleeper at bedtime and naptime.
- Place your child in the crib "drowsy but awake".
- Once placed in the crib, don't take out again.
- Visit your child as often as needed until asleep.
- For night awakenings, however, it's fine to hold your child.
- Do all of this in a loving way with a calm voice.
- Never feed until asleep.
- Never sleep in the same bed with your child.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 9/15/2011
Last Revised: 12/1/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.
